Development of the Children's ACuTe UltraSound (CACTUS) point-of-care ultrasound (POCUS)-accredited training in the UK: a descriptive study.

Point-of-care ultrasound (POCUS) is an established, evidence-supported tool that can be used in neonatal and paediatric medicine, offering clinicians immediate diagnostic insights, assessment of interventions and improved safety profiles and success rate of various procedures. Its effective use requires an established education programme, governance and standardisation to ensure competence in this skill. While adult clinical practice has established POCUS training protocols, this had not been replicated in paediatrics.

Point-of-care ultrasound as a diagnostic tool in respiratory assessment in awake paediatric patients: a comparative study.

Background: Chest X-ray (CXR) has typically been the main investigation in children with suspected respiratory pathology. Recent advances in lung point-of-care ultrasound (POCUS) have shown the potential for it to be comparative, if not better, than CXR. The objective of this study was to compare CXR with lung POCUS in children with respiratory illness in a ward-based setting at a paediatric teaching hospital.

Fifteen-minute consultation: Airway management in the acutely unwell child requiring intubation for the general paediatrician.

Emergency endotracheal intubation is a high risk procedure in acutely unwell children and is commonly jointly managed by paediatricians and anaesthetists. This article aims to develop a shared understanding of the practicalities and language around the risk factors for difficult intubation and management of failed intubation, including the approach to situations where you cannot intubate and or cannot ventilate, to improve communication and team working between these dynamic interdisciplinary teams.

Trismus in the paediatric population.

Trismus is a rare presentation affecting neonates, children, and adults. In newborns there are serious implications, with potential to affect feeding, cause airway problems, and make intubation difficult. Causes of trismus seen in the paediatric patient are discussed in this review article; they are divided into intra- and extra-articular types.

A protective effect after clearance of orthotopic rat hepatocellular carcinoma by nanosecond pulsed electric fields.

Strategies for treating liver cancer using radiation, chemotherapy combinations and tyrosine kinase inhibitors targeting specific mutations have provided longer survival times, yet multiple treatments are often needed and recurrences with new malignant phenotypes are not uncommon. New and innovative treatments are undoubtedly needed to successfully treat liver cancer. Over the last decade, nanosecond pulsed electric fields (nsPEFs) have shown promise in pre-clinical studies; however, these have been limited to treatment of skin cancers or xenographs in mice.

Histological and finite element analysis of cell death due to irreversible electroporation.

Irreversible electroporation (IRE) has been shown to be an effective method of killing cells locally. In contrast to radiofrequency ablation, the mechanism by which cells are thought to die via IRE is the creation of pores in cell membranes, without substantial increase in tissue temperature. To determine the degree to which cell death is non-thermal, we evaluated IRE in porcine hepatocytes in vivo.

Comparison of indirect and direct blood pressure monitoring in normotensive swine.

The gold standard for blood pressure measurement in pigs is direct monitoring of arterial pressure, but this is an invasive technique adding complexity to surgical procedures. We sought to compare direct measurements obtained via catheterization to more easily-obtained indirect measurements using a sphygmomanometer with an automated cuff. Simultaneous measurements via an arterial pressure transducer and a child-size cuff were performed in pigs undergoing abdominal surgical procedures under normotensive conditions.

Real-time ultrasound imaging of irreversible electroporation in a porcine liver model adequately characterizes the zone of cellular necrosis.

Background:   Irreversible electroporation (IRE) is a largely non-thermal method for the ablation of solid tumours. The ability of ultrasound (US) to measure the size of the IRE ablation zone was studied in a porcine liver model.

Methods:   Three normal pig livers were treated in vivo with a total of 22 ablations using IRE.

Targeted tissue ablation with nanosecond pulses.

In-vivo porcine studies on the effect of nanosecond high voltage pulses on liver tissue have shown that cell death can be induced in well-defined tissue volumes without damaging collagen-predominant structures. Comparison of the experimental results with the results of a three-dimensional finite element model allowed us to determine the threshold electric field for cell death. For 30, 100 nanosecond long pulses this was found to be in the range from 12 to 15 kV/cm.

Electromagnetic energy sources in surgery.

The biophysics, mechanism of actions, applications, benefits and complications of electromagnetic (EM) energy-based surgical instruments, and their current use are reviewed. Understanding the mechanism of action, tissue effects, and appropriate applications of EM devices is critical to achieving an optimal surgical outcome. Although a more diverse range of EM devices are used in human medicine, current use in veterinary medicine is limited to conventional electrosurgery and CO(2) lasers.

Large intron 14 rearrangement in APC results in splice defect and attenuated FAP.

Familial adenomatous polyposis [FAP (OMIM 175100)] is an autosomal dominant colorectal cancer predisposition syndrome characterized by hundreds to thousands of colonic polyps and, if untreated by a combination of screening and/or surgical intervention, an approximately 99% lifetime risk of colorectal cancer. A subset of FAP patients develop an attenuated form of the condition characterized by lower numbers of colonic polyps (highly variable, but generally less than 100) and a lower lifetime risk of colorectal cancer, on the order of 70%. We report the diagnosis of three attenuated FAP families due to a 1.

Effect of computed tomography display window and image plane on diagnostic certainty for characteristics of dysplastic elbow joints in dogs.

Objective: To test the effects of computed tomography (CT) image plane and window settings on diagnostic certainty for CT characteristics associated with dysplastic elbow joints (elbow joint dysplasia) in dogs and to provide optimal display guidelines for these CT characteristics.

Sample Population: CT images of 50 dysplastic elbow joints from 49 lame dogs and 10 elbow joints from 5 sound dogs.

Procedures: CT image data were obtained in transverse, sagittal, and dorsal planes.

Effect of 9 mm tibial tuberosity advancement on cranial tibial translation in the canine cranial cruciate ligament-deficient stifle.

Objective: To assess the effect of 9 mm tibial tuberosity advancement (TTA) on cranial tibial translation (CTT) in a cranial cruciate ligament (CCL)-deficient canine stifle model.

Study Design: In vitro cadaveric study.

Animals: Canine pelvic limbs (n=12).

The effect of measurement method on static weight distribution to all legs in dogs using the Quadruped Biofeedback System.

An application to measure static quadruped load distribution would be highly beneficial in the assessment of rehabilitation and lameness in many small animal patients. The scope of this study was to analyze the effects of confinement, location and local environment on the measurement of static quadruped load distribution as measured by the Quadruped Biofeedback System in normal dogs in order to better prescribe the use of this system. A prospective study of 20 healthy adult dogs was performed to evaluate effects on measurement on quadruped load distribution.

Tibial tuberosity advancement in 65 canine stifles.

The tibial tuberosity advancement (TTA) procedure was developed to treat dogs with cranial cruciate ligament deficient stifles. A retrospective, descriptive study was performed on 57 dogs that underwent unilateral or bilateral TTA. Medical records were reviewed and pre-, postoperative and follow-up radiographs were evaluated for patellar ligament-tibial plateau angle (alpha), distance of the tibial tuberosity advancement and progression of degenerative joint disease.

Surgical cytoreduction for the treatment of non-lymphoid vertebral and spinal cord neoplasms in cats: retrospective evaluation of 26 cases (1990-2005).

Medical records of 26 cats with non-lymphoid vertebral and spinal cord neoplasms treated surgically were reviewed to determine outcome and prognostic factors for survival. Of the factors examined, only tumour phenotype was significantly associated with survival. Osteosarcoma (3/26 cats) and meningioma (16/26 cats) were the most common malignant and benign tumours, respectively.

Endoscopic-assisted lumbosacral foraminotomy in the dog.

Objective: To determine if endoscopic-assisted foraminotomy significantly increased the area of the L7-S1 intervertebral foramen and if, over 12 weeks, stenosis would occur.

Study Design: Prospective, experimental study.

Animal Population: Six clinically normal, 22-29 kg, adult dogs.

One educator's perspective on the role of instructional technology in veterinary surgical education.

A brief overview of the history of instructional technology (IT) use in veterinary surgery education is followed by an assessment of the state of the art in this discipline in the United States. Comments on assessment of teaching tools and the need for a concerted effort at future assessments are made in light of published information regarding the success of alternative learning methods in education in other disciplines. A few final comments are shared about discipline specific technology demands in surgical education and the issue of copyrights versus sharing resources.

Use of computed tomographic densitometry to quantify contrast enhancement of compressive soft tissues in the canine lumbosacral vertebral canal.

Objectives: To evaluate computed tomography (CT) densitometry as a technique for quantifying contrast enhancement of compressive soft tissues in the canine lumbosacral vertebral canal and to determine whether the degree of contrast enhancement can be used to help predict tissue type or histopathologic characteristics.

Animals: 29 large breed dogs with lumbosacral stenosis.

Procedure: Contrast-enhanced CT of L5-S3 was performed by use of a previously described protocol.

Evaluation of canine lumbosacral stenosis using intravenous contrast-enhanced computed tomography.

The objective of this study was to evaluate intravenous contrast-enhanced computed tomography as a technique for predicting the within-level location(s) of compressive soft tissues in the canine lumbosacral spine. Pre-operative intravenous contrast-enhanced computed tomography of the L5-S3 vertebral levels was performed in 12 consecutive large breed dogs with lumbosacral stenosis. The images were evaluated for enhancement of soft tissues by two radiologists who were unaware of the surgical findings.

Biomechanics of the thoracolumbar vertebral column of dogs during lateral bending.

Objective: To study biomechanical characteristics of the normal and surgically altered canine thoracolumbar vertebral column to determine the effects of surgery and trauma on lateral stability.

Animals: The T13-L1 vertebral motion units of 48 mixed-breed dogs were dissected free of surrounding musculature and prepared for biomechanical testing by cross-pinning the vertebral bodies and mounting in polymethylmethacrylate.

Procedure: Normal and surgically altered spinal specimens were subjected to lateral bending.

Controlled cross circulation in dogs: effects on donor hemodynamics.

Controlled cross circulation (CCC) was performed in six pairs of dogs for 45 minutes with aortic cross clamping and cardioplegia. Data were collected in donor dogs at 10 minute intervals three times before, three times during, and three times after CCC and included arterial blood pressure, pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI), heart rate (HR), blood gas analysis, temperature, maximum rate of rise of left ventricular pressure dP/dt max/End diastolic volume (EDV), blood volume (BV), complete blood count (CBC) and activated clotting times (ACT). Pulse pressure (PP), systemic vascular resistance (SVR), oxygen delivery (DO2), and left ventricular cardiac work (LVCW) were calculated.